treatment information are not
always as clear as we might imagine. Many study participants spoke
of having multiple diagnoses and
how the ideal treatment for one
condition might contradict treatment for another.

Participants also struggled tomake sense of diagnostic defini-tions and changing treatmentguidelines. Such basic questions as“Am I diabetic or not?” and “DoI start medication now or wait tosee if losing 10 pounds makes adifference?” received conflictinganswers. Such dissonance led toquestions of trust among partici-pants who questioned the motivesand influence of the healthcare in-dustry. “Who do I believe?” “Whois looking out for me?”With so many sources of informa-tion available, study participantsstill wanted and felt they needed atrusted physician to help them ef-fectively manage their health. Theyare looking for providers who“know” them –their health status,values, and competing demands.The hallmark of nearly all of thepositive doctor-patient relation-ships in our study was compas-sion and a genuine interest in thepatient’s life.

But the study showed how difficult
it is to get what they want. For
example, a single chronic condition may require the opinion and
care of several specialties, and
no single provider seems to be in
charge, acting as a trusted center
of care and keeping track of all
information. Beyond the structural
obstacles, there were matters of
individual quality of care. Trust is
built on communication and our
study revealed that communication with physicians is a big part of
how participants measured quality.

It was the area where they felt least
satisfied.

Trust is built on communication and our
study revealed that
communication with
physicians is a big part
of how participants
measured quality. It
was the area where
they felt least satisfied.

One obvious issue is that providers and patients don’t speak the
same language. Healthcare providers talk in percentages, statistics,
and risks, while patients think in
terms of value in their day-to-day
life. While providers track objective measures like weight or blood
pressure, individuals measure
health by how well they can take
care of themselves, their ability to
interact with their family, and their
ability to work. Participants often